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Conversion to MCI and dementia in Parkinson's disease: a systematic review and meta-analysis
Dimitrios Saredakis1, Lyndsey E Collins-Praino2, Daria S Gutteridge1
1Cognitive Ageing and Impairment Neurosciences Laboratory, School of Psychology, Social Work and Social Policy, University of South Australia, Australia.
Objective:
To systematically review and meta-analyse conversion rates from normal cognition to Mild Cognitive Impairment (MCI) and dementia in Parkinson's disease (PD) patients. Reversion rates in patients with MCI (i.e. PD-MCI) were also investigated.
Methods:
Electronic searches of PsycINFO, Medline and EBSCOhost were conducted in January 2018, with 1833 articles identified after duplicate removal. Articles were included if they assessed conversion/reversion in PD patients between normal cognition, PD-MCI and PD dementia (PD-D).
Results:
In total, 39 articles met the inclusion criteria, representing 4011 patients (mean age range 58-75; 61% male). Within three years, in those with PD and normal cognition, 25% (95%CI 20-30%) converted to PD-MCI and 2% (95%CI 1-7%) converted to dementia. Of those with PD-MCI, 20% (95%CI 13-30%) converted to dementia while 28% (95%CI 20-37%) reverted back to a state of normal cognitive function. The conversion rates to MCI and dementia were higher, and reversion rates lower, when follow-up was ≥3 years. When International Parkinson and Movement Disorder Society (MDS) criteria were used to diagnose MCI, Level I criteria were associated with a greater reversion estimate from PD-MCI to normal cognitive function.
Conclusions:
These findings summarise the trajectory of cognitive impairment in PD and highlight that MCI is common in this patient group. Understanding cognitive trajectories in PD patients is important for patient care in terms of prognosis, as well as for identifying windows for intervention for cognitive symptoms. As the number of PD patients increases with an ageing population, this information can inform future policy and planning.
Insights
Mild Cognitive Impairment (MCI) is common in Parkinson's disease (PD). Within three years, 25% of PD patients with normal cognition developed MCI, and 20% of PD-MCI patients progressed to dementia.
Area of Science:
- Neurology
- Neuroscience
- Cognitive Science
Background:
- Parkinson's disease (PD) is a neurodegenerative disorder.
- Cognitive impairment is a common non-motor symptom in PD.
- Understanding cognitive trajectories is crucial for managing PD patients.
Purpose of the Study:
- To systematically review and meta-analyze conversion rates from normal cognition to Mild Cognitive Impairment (MCI) and dementia in Parkinson's disease (PD) patients.
- To investigate reversion rates from PD-MCI back to normal cognition.
Main Methods:
- Systematic review and meta-analysis of electronic searches (PsycINFO, Medline, EBSCOhost).
- Inclusion criteria: studies assessing conversion/reversion in PD patients between normal cognition, PD-MCI, and PD dementia (PD-D).
- Data synthesis from 39 articles representing 4011 patients.
Main Results:
- Within 3 years, 25% of PD patients with normal cognition converted to PD-MCI (95%CI 20-30%) and 2% to dementia (95%CI 1-7%).
- Of PD-MCI patients, 20% (95%CI 13-30%) converted to dementia, while 28% (95%CI 20-37%) reverted to normal cognition.
- Longer follow-up (≥3 years) showed higher conversion and lower reversion rates. International Parkinson and Movement Disorder Society (MDS) Level I criteria for MCI diagnosis were associated with greater reversion estimates.
Conclusions:
- MCI is a frequent occurrence in Parkinson's disease patients.
- Cognitive trajectories in PD are dynamic, with both progression and reversion observed.
- Findings are vital for prognosis, intervention timing, and future healthcare policy for the aging PD population.